Adachi Naoto, Matsuura Masato, Hara Tsunekatsu, Oana Yasunori, Okubo Yoshiro, Kato Masaaki, Onuma Teiichi
Adachi Mental Clinic, Sapporo, Japan.
Epilepsia. 2002 Dec;43(12):1574-82. doi: 10.1046/j.1528-1157.2002.22402.x.
To evaluate further the relevance of designating psychotic episodes as either postictal or interictal, we compared several biologic variables between epilepsy patients with and without psychosis.
The study subjects comprised 282 patients with psychosis (36 with postictal psychosis, 224 with interictal psychosis, and 22 with both postictal and interictal psychoses, i.e., bimodal psychosis), and 658 epilepsy patients without psychosis. The clinical characteristics of these patients were reviewed retrospectively by experienced neuropsychiatrists. Factors predicting the development of each type of psychosis were determined by serial multivariate logistic regression analyses.
Factors that were comparable between postictal and interictal psychoses were intellectual function, family history of psychosis, epilepsy type, and the presence of complex partial seizures. In contrast, age at the onset of epilepsy and at the onset of psychosis and the presence of generalized tonic-clonic seizures differed for the three types of psychosis. Patients with bimodal psychosis showed characteristics associated with both postictal and interictal psychoses.
This study documented conditions, including both general factors and epilepsy-related factors, common to epilepsy patients with psychosis, regardless of chronologic distinctions. Certain epileptic processes appear to have equal influence on postictal and interictal psychoses. However, some differences between postictal and interictal psychoses suggest that these chronologic descriptors are valid. Our findings confirmed that psychosis associated with epilepsy should not be defined as a single, simple condition but rather as a complex condition with several possible subcategories.
为了进一步评估将精神病发作区分为发作后或发作间期的相关性，我们比较了有精神病和无精神病的癫痫患者之间的几个生物学变量。
研究对象包括282例患有精神病的患者（36例发作后精神病患者，224例发作间期精神病患者，22例同时患有发作后和发作间期精神病，即双峰型精神病），以及658例无精神病的癫痫患者。经验丰富的神经精神科医生对这些患者的临床特征进行了回顾性分析。通过系列多变量逻辑回归分析确定每种类型精神病发生的预测因素。
发作后和发作间期精神病之间可比的因素包括智力功能、精神病家族史、癫痫类型以及复杂部分性发作的存在。相比之下，癫痫发作起始年龄、精神病发作起始年龄以及全身性强直阵挛发作的存在在三种类型的精神病中有所不同。双峰型精神病患者表现出与发作后和发作间期精神病相关的特征。
本研究记录了癫痫伴精神病患者共有的情况，包括一般因素和癫痫相关因素，而不考虑时间顺序上的区别。某些癫痫过程似乎对发作后和发作间期精神病有同等影响。然而，发作后和发作间期精神病之间的一些差异表明这些时间顺序描述是有效的。我们的研究结果证实，与癫痫相关的精神病不应被定义为单一、简单的情况，而应被定义为一种具有几种可能亚类的复杂情况。
